Trump Proposes Deep Cuts In Detecting Disease Outbreaks Worldwide

In August 2014, Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, talked with Doctors Without Borders staff during a visit to an Ebola treatment center in Monrovia, Liberia.

Tommy Trenchard for NPR

There's a glaring hole in President Trump's budget proposal for 2019, global health researchers say. A U.S. program to help other countries beef up their ability to detect pathogens around the world will lose a significant portion of its funding.

The ambitious program, called Global Health Security Agenda, was launched in early 2014, aiming to set up an early-warning system for infectious diseases across the world.

After the Ebola outbreak later that year the program was significantly ramped up with an additional $120 million dollars a year to expand the building of disease-detection systems to dozens more developing countries around the world. That ramped-up funding runs out in September 2019. And while Trump is keeping the original program he has not proposed continued funding at the current level.

Congress, which has the responsibility to adopt the budget, could end up restoring the funds.

Still, the proposal has critics worried. "Cutting this money is shortsighted," says Dr. Paul Spiegel, who directs the Center for Humanitarian Health at Johns Hopkins University. "By downsizing this program, outbreaks may not be detected as quickly now, and in the end, the U.S. could wind up spending more money [to stop an emergency outbreak]."

In Trump's proposal, funding for the program would drop by about two-thirds, from about $180 million each year to about $60 million each year. As a result, the Centers for Disease Control and Prevention is planning to downsize its operations — or even close up shop — in 39 countries by September 2019. It will continue its work in 10 countries.

For decades, the CDC has been helping other countries stop dangerous, fast-spreading outbreaks, such as SARS in 2009. But a few years ago, the agency decided to try a different approach: Help other countries set up their own disease-detection facilities so they can find outbreaks before they spiral out of control.

Global Health Security Agenda has goals such as building laboratoriesthat can test biological samples and creating a network of health workers who can detect dangerous diseases when they crop up.

At first, the CDC had only about $60 million in its budget for the program. Then in the summer of 2014, Ebola struck West Africa. The U.S. ended up spending billions of dollars to stop the outbreak both overseas and here at home. And all of a sudden, there was much more interest for the CDC's new disease-detection program. Congress allocated an extra $600 million to be used over five years.

Without that kind of funding, critics say progress made since 2014 will falter. "It takes years to set up a disease surveillance system in a country," Spiegel says. "It's a waste of money to stop now and leave a country after you've already invested a few years into the process."

Over the past few years, the CDC has used the extra funding to train more than 1,400 epidemiologistin 17 countries. And 16 countries now have a full-time epidemiologist dedicated to training more disease detectives, funded by this money as well.The program has also helped to stop several outbreaks in poor countries, including cholera in Cameroon and measles in Pakistan.

None of these outbreaks were close to coming to the U.S., as Ebola and SARS did. But scaling back this work still makes America vulnerable, says Ashish Jha, who directs the Harvard Global Health Initiative.

"We don't need to panic over these funding cuts," Jha says. "It's not like 'Oh my gosh! We need to fix this right away.

"But the cuts are a big deal," he says, "because infectious disease outbreaks are increasing not decreasing, and we are becoming more interconnected, not less interconnected."

And so, Jha says, the federal government is going in the wrong direction. "We should be increasing our investment in GHSA, not decreasing it," he says. "The program is really a great bang for the buck."